Healthcare Provider Details

I. General information

NPI: 1073946117
Provider Name (Legal Business Name): MARY ANN ANDERSON-PARRIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 VETERANS PKWY S
MOULTRIE GA
31788-6705
US

IV. Provider business mailing address

101 4TH AVE SW
CAIRO GA
39828-2925
US

V. Phone/Fax

Practice location:
  • Phone: 229-985-4815
  • Fax:
Mailing address:
  • Phone: 229-377-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN122052
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN122052
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: